Health Plans

Streamlined Success

Achieve compliance and strategic network management objectives and outcomes with a streamlined, comprehensive approach to provider data management.

PROVEN, CONFIGURABLE SOLUTIONS

Your members deserve access to quality providers within your health plans. Streamline network administration with Verisys’ configurable credentialing platform powered by quality provider data to increase revenue by accelerating enrollment and lower operational costs by reducing false claims.

See how health plans use Verisys to credential and enroll providers to ensure quality care with optimal outcomes.

  • Provider Directory meets compliance and consumer demands for easy-to-use online, mobile, and printed formats.
  • Screen and monitor providers for exclusions and sanctions with Verisys’ gold standard database FACIS – Fraud Abuse Control Information System.
  • Data Services improves data accuracy, timeliness, and quality by eliminating inaccurate and incomplete provider data.
  • Credential and enroll providers with CheckMedic, Verisys’ comprehensive credentialing SaaS platform that provides user-friendly dashboards for turnkey provider data management. A unique secure digital profile, a MedPass is created for each individual and entity.
  • Streamline and consolidate siloed administrative duties with Verisys’ Network Management solution that strengthens your provider relationship management with a custom Salesforce app.
  • Instantly verify prescriber credentials with ProviderCheck, Verisys’ real-time transaction engine that issues a pass/fail on five key data points.
  • Verify a provider’s history and status of all licenses held nationwide with Verified License Search and Status, VLSS.

There’s a lot under the Verisys hood

High standards:

Verisys is the only Credentials Verification Organization (CVO) that is National Committee for Quality Assurance (NCQA) certified for 11 out of 11 verification services, is Utilization Review Accreditation Commission (URAC) accredited, and is ISO 9001:2015 (quality management), ISO 27001:2013 (information security), and AICPA SOC 2 (customer data security) certified.

Data platform:

Verisys’ comprehensive data platform contains more than 320 million aggregated records derived from thousands of primary sources — and growing. Data collection began in 1992 with its Fraud Abuse Control Information System (FACIS). Verisys stores cumulative records that provide a unique, longitudinal view of exclusions, debarments, sanctions, and disciplinary actions.

Data matching science:

Verisys developed a proprietary matching logic using algorithms in combination with oversight by data analysts to collect, transform, and match each piece of data to the right provider/entity consistently with 99.9% accuracy. We stand behind our results 100% of the time.

Technology:

Our innovative technology stack transforms millions of records into intuitive, interoperable formats. This powerful solution simplifies workflow for turnkey compliance and a better bottom line.

Software:

Verisys designed and built the first data-powered Software as a Service (SaaS) credentialing platform, CheckMedic 20 years ago. Solutions innovation continued with real-time search and transaction engines, VerisysConnect, and ProviderCheck that instantly deliver accurate provider data when you need it. These unique, comprehensive solutions streamline provider data management, credentialing, privileging, and enrollment.

From the Verisys Blog

What is CVO Credentialing?

What is CVO Credentialing?

CVO credentialing refers to the use of a Credentials Verification Organization to perform medical credentialing on behalf of a healthcare practice or organization. The CVO verifies a provider’s credentials by obtaining primary source verification of a provider's qualifications on the organization’s behalf. Upon verification, a provider may then enroll in payers' health plans so that the healthcare organization can be reimbursed for services. Credentialing healthcare providers can include verification of their license, education, medical training, work experience, and other qualifications that confirm their status. The CVO acquires documents...

read more
Telehealth: Modern Health Management

Telehealth: Modern Health Management

In the past, the standard for medical treatment was to arrive at a healthcare facility to be diagnosed and treated. The advancements in technology and COVID-19 have rapidly altered that norm with telehealth becoming the “new norm.” Telehealth is defined as the delivery of healthcare services at a distance through the use of technology. It can include conducting medical visits over the computer or phone, monitoring patients' vital signs remotely, communicating via patient portals, and managing and training healthcare staff via video. The COVID-19 pandemic has accelerated telehealth as policies rapidly changed to meet the demand for remote...

read more
What Is the Process of Getting Credentialed with Medical Insurance Companies?

What Is the Process of Getting Credentialed with Medical Insurance Companies?

The process of getting credentialed with medical insurance companies is also known as provider enrollment and is the first step of the process for inclusion into payment panels. While the process can be time-intensive, provider enrollment is the only way a healthcare provider organization can become an in-network provider and be paid by insurance companies. Although enrollment requirements differ among payers, these steps will get you started. Don’t sleep on the process; getting enrolled and credentialed with an insurance company can take anywhere from 90 to 150 days. Missteps or postponement can cause cash flow delays and scheduling issues...

read more